Page 11 - TheAlaskaNurseOctNov2018

Difficult questions, conversations and situations are After being discharged, he came to the unit to visit
unavoidable, especially in the CCU. As a nurse, you with his son. It was painful to watch the two clutch onto
naturally want the best possible outcome for your patients. one another, each carrying hope for the other. We tried to
Sometimes the best outcome means allowing a patient’s explain to the family that JR may not recover and maybe
journey to come to a close. I hadn’t realized the impact or it would be best to allow him to pass away peacefully. His
the importance of advocating until I came across a patient dad was clearly upset and was not ready to make this
who not only changed my life, but changed the direction decision.
of my nursing career. My newly learned critical care skills,
Another day passes. JR remains on life support and
combined with my timid confidence, made approaching
lightly sedated. Our conversation has become one-sided,
the intensivists with my unsettling feelings difficult. At
as he can no longer talk. I share with him game updates
the same time, sitting idle and continuing to provide care
and turn on every Dodger game I can. I mistakenly put on
to a patient who made his wishes clear was even more
a Yankee game and teasingly asked, “Why didn’t you tell
distressing.
me the Yankees were playing!?”
It was the end of May. I was assigned to take care of
I removed JR’s restraints, as I didn’t see them necessary
JR. He had a seizure disorder which resulted in him falling
at the time. The doctor asked me to lighten his sedation
and leaving him with multiple brain injuries over time, with
to see if he would become more interactive. I briefly went
this last episode being the worst. Because of his head
to check on my other patient, only to be called back to
injury, he had a hard time expressing his thoughts, which
JR’s room by his alarming vent. When I got to him, he had
made him more anxious and tearful. He would forget things
removed the circuit from his neck and removed the only
almost immediately, so he repeated the same question
IV access I had to make sure he was comfortable. He was
multiple times. This became frustrating for him very quickly,
crying and thrashing his head, which only worsened when
so I decided to just sit with him. Once he was no longer
I asked to place a new IV. His heart rate was nearing the
anxious, he shared his life before seizures, about his dream
180’s, causing me to panic. I was finally able to calm him
of being a firefighter, his dogs, his thoughts on politics, his
enough to explain he needed an IV, so I could keep him
hatred for the “damn Yankees” (his dad’s favorite), and his
comfortable. After he settled, I had to restrain his hands
favorite team: the LA Dodgers.
for his own protection. I ensured he was comfortable, and
I learned he and his dad were best friends. They took just sat with him and cried. I told him I was so sorry, and I
care of one another, as they could never live independently. promised I would once again encourage his family to allow
When one got sick, the other stressed and vice versa. It him to go peacefully.
was impossible for one to see life without the other.
That night after work I went to my favorite bar and had
I worked with JR for several days, encouraging him to a shot of Fireball whisky. I wanted a shot that wasn’t so
remember who I was and why he was in the hospital. By terrible I couldn’t stand it, but still something that tasted
the end of the week he was getting up into a chair
CoNTiNued oN Page 12
and eating again. He had improved enough to be
transferred out of the ICU. As JR was progressing
forward, his uncle became our next ICU patient.
When it came time for JR to transfer, his uncle
seemed to be stable. Only a few days later, his
uncle had a heart attack and passed away.
Around the same time, JR aspirates while eating
and develops respiratory failure. This time while
he’s in the ICU, he requires life support.
JR’s dad is not only grieving the loss of his
brother and must prepare his funeral, but is
now being told his son is back in the ICU on life
support and has developed severe respiratory
failure. He is unable to be removed from the
ventilator, forcing the family to have to make
the difficult decision whether or not to have a
tracheostomy, a tube providing an airway to the
lungs, placed placed. They agreed on placement
with the hope of JR recovering and returning
home. The heartache becomes too much for JR’s
dad, and he too is admitted to the hospital for
heart complications.
The auThor aTTeNds aN aNChorage gLaCier PiLoTs game This summer
wiTh her NieCe aNd soNs

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